This is a multicenter, prospective, randomized clinical trial to compare DSRS and TIPS for the management of variceal bleeding in patients with Child's Class A or B cirrhosis. The primary goal of both therapies is to achieve control of variceal bleeding by reducing pressure in the varices, and limit the risk of accelerating the development of liver failure, ascites, and hepatic encephalopathy. The study will randomize patients who have failed or are not candidates for endoscopic therapy.